Transmastoid Middle Fossa Craniotomy Repair of Superior Semicircular Canal Dehiscence Using a Soft Tissue Graft

Abstract

Transmastoid craniotomy repair of the superior semicircular canal dehiscence using a soft tissue graft offers numerous advantages over traditional surgical approaches and can be performed safely in the outpatient setting. The strategy is particularly useful in patients with dehiscence at the superior petrosal sinus. This article will review our strategy and discuss the advantages and disadvantages of the different surgical treatments used for patients with severe symptoms from superior canal dehiscence.

Evolution in surgical management of superior canal dehiscence syndrome

“…Kirtane reported success in plugging the superior canal through a standard mastoidectomy. A modified resurfacing repair for superior semicircular canal dehiscence through a transmastoid approach was described [6][7][8]. This technique, modified from the posterior canal occlusion techniques described by Lorne Parnes as an option for patients with benign paroxysmal positional vertigo [4], has the advantage over the more traditional middle cranial fossa exposure in that no craniotomy was performed.…”

Superior Semicircular Canal Dehiscence Syndrome – Diagnosis and Surgical Management

“…13 When surgery is necessary, the bony dehiscence can be resurfaced, plugged or capped by different surgical approaches. [14][15][16][17][18] Middle Cranial Fossa Approach This approach to treat SSCD syndrome was first described by Minor et al 14 A 4Â4 cm craniotomy is drilled. The temporal lobe is retracted, and the arcuate eminence is identified.…”

“…In patients with dehiscence at the superior petrosal sinus, the sinus was exposed at the sinodural angle, posterior to the solid angle, and followed to the superior canal. 16 Two points of the bony labyrinth are fenestrated with a 1 mm diamond burr, and the endosteum is opened just inferior to the fenestrated apex of the superior canal, on the ampullated and non-ampullated portions of the canal. 19 Care is taken to avoid suction or manipulation of the membranous labyrinth to prevent hearing loss or chronic disequilibrium after surgery.…”

“…The dura and overlying temporal lobe or superior petrosal sinus will stabilize the position of the graft, with no tendency to extrude. 16 It is well known that the transmastoid approach avoids the risks of performing a craniotomy in the middle fossa, resulting in lower morbidity and a shorter hospital stay. The disadvantage of transmastoid procedures is that the dehiscence is visualized with more difficulty compared to the middle fossa approach.…”

Superior Semicircular Canal Dehiscence

“…Araştırmacılar, perikondrium ıslandığında mekanik olarak stabil olması nedeni ile fasiyal greftlere oranla daha kolay yerleştirilebileceği için tercih etmişlerdir. 30 Schwartz ve ark. yaptıkları çalışmada, transmastoid ve orta fossa yaklaşımlarını karşılaştırmışlardır.…”